Tobacco angina; an electrocardiographic study.

S INCE Huchard used the term tobacco angina in 1899,' there has been much discussion of the relation which it suggests, but few definitive studies of this relation have been published. A review of the literature reveals only two case reports which present objective evidence of myocardial ischemia during angina*1 seizures induced by smoking. 2 It is the purpose of this paper to discuss some of the cardiovascular effects of tobacco and some observations in sixteen patients with angina pectoris .in whom electrocardiograms were taken immediately after the patient had smoked two cigarettes. Numerous observers have expressed the opinion that a close temporal relation between the use of tobacco and the onset of cardiac pain is exceedingly rare.3-5 The majority of articles dealing with tobacco angina present little or no evidence that smoking is a cause of angina1 seizures.1*5-12 Investigation of the effects of tobacco in man have been concerned mainly with the response of the peripheral vascular system. It is generally agreed that smoking usually induces arteriolar constriction, accompanied by lowering of the temperature of the skin and elevation of the blood pressure, pulse rate,13-21 and blood sugar.22 There are, however, various opinions with respect to the particular products of smoking responsible for these phenomena and the mechanisms through which they are effected. The question of an allergic response to tobacco smoke in certain cardiovascular diseases has been raised, but the evidence bearing upon it is inconclusive.16'16'23-25 There are many observations indicating that nicotine alone is capable of producing many of the reactions caused by smoking, 16~19~20~26-28 but SOme investigators believe that the same cardiovascular responses are induced by smoking material that does not contain this drug.20 The initial effect of nicotine is to stimulate, but its subsequent and more prolonged action is to depress the para-sympathetic and sympathetic ganglia, central nervous system cells, and skeletal